Clinical Practice Reflection

Leadership can be described as a quality that influences the people for achieving any purpose or any set of goals. However, leadership and management are not the same and differentiating leadership from the management results in the origin of confusion in many cases. It is quite evident that all leaders can be good managers but not every manager can be an effective leader, hence, making the leadership a vital aspect of better and effective management (Chapparamani & Jyothi, 2011). The work of various behavioral theorists provides insights into the democratic, autocratic, and laissez-faire styles of leadership, which impacts the organizational performance to a large extent. Despite the several conceptualizations based on the leadership, there are many authors that agree on the fact that leadership is a process, which includes influence, takes place in groups, needs an adaptive and goal seeking approach, as well as, occurs at all the levels. No doubt that leader are the ordinary people only who perform extraordinary things through the better use of power in formulating the future. Hence, this implies that the individuals as leaders are judged mostly by the consequences based on their behavior in spite of their physical characteristics (Thomas, Bellin, Jules, & Lynton, 2012). This essay is basically a reflective essay based on the experience during clinical practice, which will reflect my own leadership qualities demonstration and development and the process that helped in analyzing the situation and implications of the leadership roles in the future. 

As we all know that nursing leadership compasses from staff nursing involved in caring the patient to the nurse who is an in charge of a hospital, the nurses should acquire the effective and appropriate leadership skills. Nursing leadership requires to be focused on the people, as well as, on the problem-solving ability in an ever demanding atmosphere of the health care system (Nazarko, 2004). Hence, with the use of Gibb’s reflective cycle, I will reflect on the incidence of care that I was involved in during my clinical placement. As Gibbs cycle involves  six different stages it will improve my learning from the situation I experience and will help in improving my nursing practice in the future. The Gibb’s cycle involves the description of the situation, analysis of the personal feelings that I have experienced during the situation, evaluation of the overall experience I had from this situation, analysis of the situation, conclusion, and action plan which will prepare in case the same situation arises in the future (Black & Plowright, 2010).  Reflection is helpful in generating the practical knowledge, leads to the development of the self-esteem, helps an individual in assisting the abilities that will help in adaptation to the new situations, and generates satisfaction towards the professionalizing practice. It is the process of gaining confidence, improvement, self-awareness, and learning things from own behavior and mistakes that improve the future through the process of learning from the past (Gomez, 2014). Moreover, through the process of reflection one can have a good understanding of the things  they do and what can limit our abilities, thus providing the opportunity for improving the way an individual can care in a health care system (Duffy, 2007).

To use the situation for my reflective essay, I would not use the original personal details of the patient. To protect the patient’s identity, as well as, to maintain the client’s confidentiality,  I will address the patient as ‘Joy’, as according to the NMC code of professional conduct, it is the duty of a health practitioner to protect the information of the patient and should treat the information as confidential unless it is required for the given purpose with the consent of the patient (“Nursing & Midwifery Council Code Of Professional Conduct”, 2002). During my clinical practice placement, I once got a chance to assist a patient named Joy who was a 70-year-old man and was shifted from an emergency department. The patient was suffering from urinary retention and had a considerable pain. During his handover, my mentor  and I were told that we have to take care of Joy on that shift, and were also requested to change the dressing of Joy’s right leg as his right leg was ulcerated due to the condition called as Peripheral Vascular Disease. Moreover, due to this disease, Joy also had an amputation of his left leg below the knee a few years ago due to which he was mobilized with the help of a wheelchair. It was quite evident during his handover that Joy was very difficult for the past two days. Further, the nurse in charge of the emergency department told us that he used to throw things across his room and used to press the nurse call button constantly and was shouting throughout the day. He had also denied  changing his pajamas and didn’t have a wash. After his handover from the emergency department, my mentor told me that we should now change the dressing of Joy but he should be first cleaned and get him changed and if I could assist her in that. We then  gathered the required equipment from the treatment area and proceeded towards Joy’s room. As soon as I entered his room, I saw that Joy was sitting on his bed and was quite tense. I then introduced myself to him as a student nurse and asked his consent to assist in his washing and changing clothes. He looked and shouted as soon as he asked his consent. He said that he only wants to see the doctor and stated that he didn’t smoke a cigarette for the past couple of days. I explained him very politely that I would be assisting in changing and applying the dressing of his right leg and prior to it he should have a wash, as well as, change his clothes.  I then continued to engage him in the conversation by maintaining a slow and soft tone. Further, I asked him that should I send a cup of tea for him after the procedure. I noticed a change in his body language and he was softened in his language and smiled with the approval of sending a tea. I smiled and repeated that if he could allow me to assist in washing and changing clothes in a very polite and relaxed posture. Joy allowed me and I proceeded in maintaining the personal hygiene and cleanliness with dignity and respect. Moreover, with Joy’s cooperation we were able to proceed with changing his dressing. 

Through this clinical practice situation, I experienced different feelings. As the nurse in charge created a negative picture of Joy during the initial handover and described him to be ‘difficult’, I wondered why the patient was so demanding and aggressive. I felt very nervous and anxious during the handover as it was the first time I was going to assist the patient directly and did not have enough experience of dealing with the situation. However, after meeting Joy I was clear about the reason why he was frustrated and angry. To my notice, I observed that there was no wheelchair in Joy’s room, and without a wheelchair, Joy was just confined to his bed, which led to the loss of his autonomy. Further, it was clear that Joy was a smoker and he was not put on nicotine replacement therapy for helping him to cope up with the withdrawal symptoms. Hence, the loss of his autonomy and inability to cope up with the withdrawal symptoms has made him feel frustrated and angry. On analysis of his situation, I also felt frustration for him and at the same time made me angry.  

From the situation, I evaluated that there was a breakdown in the development of the nurse-patient communication and relationship, which made the patient frustrated and angry (Evans, 2013). The communication skills and compassion of the nurse in charge was not sufficient for understanding the patient. She was not listening to the client’s requests and was not showing an empathetic attitude towards the client, which is very much required for the development of a healthy therapeutic relationship amongst the two (Hodson, 2013). This incident enables me to self-examine and to find out my short fallings that  I had to the incident. Moreover, I was able to associate theory to the practice through this incident. The foremost quality of a good leader is having good communication skills (McGough, 2007). Through this incident I realized that I had the communication skill as an outcome of communicating with Joy was positive and the personal hygiene goal was met. Self-awareness is considered to be the foundation of an effective management and is an important quality and skill required in leadership. To provide high standard care and improving the performance one must require management of the cognitive, behavioral, and affective self to engage the health care professional in therapeutic relationships (Pavlovich, Collins, & Jones, 2008).  It involves an understanding of own beliefs, motivations, thoughts, limitations, biases and recognizing their impact on the provision of the health care services. It is very necessary being a student nurse that there must be complete awareness of strengths, as well as, weaknesses (Martin, 2012).  The incident made me realize that I was not comfortable in questioning the nursing care and should have acted in a more assertive manner as Joy’s basic needs were ignored.  However, in the future I will be more assertive and will question if there is any bad practice or needs of patients are not carried out properly in the future, because as  per NMC, the person is accountable for their own omissions and actions in the practice and one should always be capable of justifying their own decisions (Sutcliffe, 2011).

The situation needed the implementation of the interpersonal skills, both verbal and nonverbal communication technique. Nonverbal communication can be described as the transmittance of information without speaking. Joy’s body language clearly indicated the anxiety and tension he was having and hence, approaching Joy with empathetic attitude ensured that his participation in the communication is appreciated and he was understood (Peate, 2009). Verbal communication was enhanced by utilizing the facial expression, as well as, paraverbal communication, which included pitch, tone, volume, and speed while speaking, hence communicating in a soft tone added more meaning and value to the words (Hofert, Burke, Balighian, & Serwint, 2015).

The participation in the clinical practice and through Gibbs’s reflective cycle, I’m able to recognize the way of putting the learning experience as a useful asset in my clinical practice in the future as a nursing professional. In case, I have to face the same kind of situation in the future, I learned that I require to show more assertiveness and should show the courage of questioning the attitude of the nurse at an initial stage as ‘bad practice’ is not acceptable. If I feel that the patient’s requirements are not fulfilled, my primary consideration must be the protection of the safety and interest of the patient as per the NMC Code of Professional Conduct (“Nursing & Midwifery Council Code Of Professional Conduct”, 2002).

The nurse plays a vital role during the provision of healthcare services to the patient. The development of the therapeutic relation between the nurse and the patient is very important. By use of effective communication skills a good and effective therapeutic relation can be developed (Peate, 2009). From this experience and through this reflection, I learned that the use of communication skill is the most important and necessary skill for carrying out the care of the patient. Moreover, I was able to demonstrate the importance of ethical practice and one should always objectify if the needs of the patient are not met. Further, the development of effective communication needs as much consideration and practice as is required by other aspects of nursing (Disser, 2003).

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